Insurance isn’t the most exciting part of running a home care agency, but it matters more than most owners realize — especially when something goes wrong. In home care, your teams aren’t working in neat hospital hallways; they’re stepping into clients’ lives, homes, and routines.
That freedom to deliver personal care also brings unpredictable risks: a slick bathroom floor, a caregiver’s drive between visits, a misplaced phone with client information. These are the kinds of real-world moments that turn into insurance claims if you’re not prepared. And when they do, the ripple effects touch more than just the bottom line — they affect trust, morale, and your agency’s reputation.
That’s why understanding the right coverage — from liability to workers’ comp to cyber protections — isn’t just insurance jargon. It’s about protecting your mission: caring for people well and sustainably. And when you pair smart coverage with thoughtful tracking of things like falls, missed visits, and turnover, you build a safer, stronger agency from the inside out.
To shed some light on the same, we interviewed a home care industry expert to bring his perspective on insurance risks every home care agency must master.
Mike brings nearly two decades of experience in insurance, risk management, and employee benefits, helping home care agencies build thoughtful, cost-conscious protection. He takes a consultative approach that goes beyond transactional sales to deliver tailored coverage and peace of mind.
Mike also guides agencies through compliance, safety standards, and workers’ compensation strategies that improve outcomes and reduce losses. As a trusted advisor at HUB International, he partners with home care leaders to protect people, operations, and long-term growth.
Let us now delve into what he has to say about insurance risks every home care agency must master.
While there are several essential coverages one should consider for a well-insured home care agency, those that offer protection from the highest risks – risks most likely to result in a costly claim – are General and Professional Liability, Crime and/or Fidelity, Hired and Non-Owned Auto Liability, and Workers’ Compensation
General and Professional Liability are arguably the most critical lines, affording an agency coverage for claims of bodily injury and/or property damage (General Liability), and for any actual or alleged act, error, or omission in the rendering of professional services to others (Professional Liability).
Common examples of General Liability claims include slips, trips, and falls, such as a client tripping over an area rug while under a caregiver’s supervision, or slipping on a wet bathroom floor after bathing. While less common, property damage claims can also result from a caregiver’s carelessness, such as when performing light housekeeping or handling a prized family possession.
Professional Liability claims, on the other hand, are most often related to the failure to follow a care plan or adhere to treatment protocols. Other examples include general neglect, such as the failure to provide necessary hygiene, nutrition, or assistance with activities of daily living (ADLs).
Agencies should consider carrying high liability limits across all significant lines of coverage, especially General and Professional Liability. Additionally, an Umbrella or Excess Liability policy is recommended as a cost-effective means to achieve greater protection. Coverage for allegations of sexual abuse and molestation, as well as physical abuse and neglect, is also a must.
Theft of Client Property coverage, often secured through a Fidelity Bond or Crime Insurance, is crucial for a home care agency because it directly protects the agency from financial and reputational harm caused by dishonest employees. Since caregivers have unsupervised access to clients’ homes and valuables, this coverage shields the agency from vicarious liability—the legal responsibility for an employee’s criminal actions.
A prime example of a claim would be a caregiver who, after working for several months and earning the client’s trust, steals the client’s rare coin collection, or an expensive designer handbag, or uses the client’s debit card to withdraw cash. The insurance would cover the agency’s costs to reimburse the client for the stolen items and defend against any resulting lawsuit, allowing the agency to maintain client confidence and protect its standing in the home care community.
In some states, or in specific business contracts, this coverage is not optional—it is required. For example, California, which requires a Home Care Organization Dishonesty Bond, mandates this coverage for a home care agency to obtain or retain a business license. Additionally, Regional Centers, senior living facilities, hospitals, physician groups, and other major referral partners may require the agency to have a specific fidelity bond or theft-of-client-property coverage before they agree to work with the agency or refer business.
Home care agencies should, at minimum, ensure they have coverage for Employee Theft or Dishonesty (covers loss or damage to money, securities, and other property resulting directly from theft committed by an employee, whether identified or not, acting alone or in collusion with other persons – think embezzlement); Computer Fraud (covers loss of or damage to money, securities and other property resulting directly from the use of any computer to fraudulently cause a transfer of that property from inside the premises or banking premises to a person, other than a messenger, outside the premises or to a place outside the premises); Funds Transfer Fraud (covers the loss of funds resulting directly from a fraudulent instruction directing a financial institution to transfer, pay or deliver funds from your transfer account); and Theft of Client Property (covers the loss of or damage to money, securities, and other property sustained by your client resulting directly from theft committed by an identified employee, acting alone or in collusion with other persons). The limits of insurance should be determined by analyzing the agency’s financial operations and controls, risk exposure, risk tolerance, and franchisor- or referral partner-imposed compliance requirements, and by consulting with a CPA and an insurance agent or broker.
In short, an in-home care agency should consider this insurance because the risk of an employee stealing from a client is high, the cost of defending the resulting lawsuit is steep, and the damage to the company’s reputation can be severe.
Hired and Non-Owned Auto Liability (H&NOA) insurance is crucial for a home care agency because it protects the business when caregivers or administrative employees drive any vehicle not owned by the agency, or those vehicles that are rented, leased or borrowed by the agency—including employees’ personally-owned vehicles, client-owned vehicles, or vehicles rented by employees on behalf of the agency—for work-related tasks. Since caregivers frequently drive between shifts or run client errands, home care agencies face significant legal risk.
Suppose an employee causes a severe accident while on the clock, the agency can be held directly responsible for all injuries and damages. H&NOA coverage fills a significant gap: it steps in when the employee’s or client’s liability insurance will not cover the loss, or when the limits are too low to cover a substantial lawsuit, ensuring the agency’s assets are protected from catastrophic financial loss.
Further, a home care agency should understand that an employee’s personal auto policy limits are often inadequate for business-related claims. Most employees carry the minimum liability limits required by their state, which is sufficient for minor, personal accidents. However, home care agencies are exposed to a much larger risk because a serious accident —especially one resulting in catastrophic injury or death — can easily lead to a lawsuit demanding six to seven figures or more. Since the employee’s personal insurance will stop paying once the policy limit is reached, the remaining damages are then pursued directly from the agency’s assets. This significant gap is precisely why Hired and Non-Owned Auto Liability coverage is essential; it provides the high-dollar protection needed to cover the difference and shield the agency when the employee’s or client’s personal auto policy limits are exhausted, or coverage is outright denied.
Because all home care agencies have employees who drive on behalf of the company, agencies should add Hired and Non-Owned Auto Insurance to either a Commercial Auto policy or as an endorsement to the agency’s General Liability policy if the agency does not own any autos. Additionally, adding the Employee As Insured endorsement (commonly known as the CA 99 33 form in Commercial Auto policies) provides a crucial layer of protection for employees who use their personal vehicles for work-related tasks on behalf of their employer, extending the home care agency’s Commercial Auto Liability to the employee, but only when they are driving their own vehicle for business purposes, such as when transporting a client or running an errand.
In-home care agencies face significant workers’ compensation risks due to the unpredictable nature of home environments, which lack standardized safety measures. This uncontrolled setting contributes to high occupational injury rates among caregivers, including common and costly musculoskeletal injuries from client handling; slips, trips, and falls; needlestick and sharps injuries; exposure to harmful substances and infectious diseases; and, in rare circumstances, potential violence.
The resulting complex claims and challenges in proving work-relatedness in a home setting lead to increased insurance costs and potential litigation.
To effectively structure Workers’ Compensation coverage, home care agencies must ensure administrative accuracy from the start. This includes using correct classification codes to distinguish between different roles, such as caregivers and administrative staff, which is essential for accurate premium calculation. Furthermore, maintaining clear, up-to-date job descriptions that detail physical requirements and duties provides crucial documentation for managing claims and verifying that injuries occurred within the scope of employment.
Prompt and efficient claim management is also vital for controlling costs and preventing legal complications. Agencies must establish strict protocols for immediate injury reporting to their insurance agent or broker, or carrier, as timely communication is key to successful resolution. Additionally, defining a precise scope of care and ensuring that services do not deviate from the originally agreed-upon scope can help avoid liability issues, caregiver injuries, and claim disputes.
Finally, proactive monitoring of the home care agency’s Experience Modification (Ex-Mod) is necessary. Regularly reviewing loss history with an insurance agent or broker helps the agency understand how past claims affect current and future premiums and identify specific areas where safety improvements and risk mitigation strategies are needed.
Home care agencies should actively track and regularly review the following three critical loss-trend metrics, essential for controlling soaring insurance premiums and maximizing operational stability.
The Client Incident Rate is a key figure that shows how often an agency faces problems severe enough to trigger a general or professional liability claim. It’s a direct measure of risk exposure in these areas. Home care agencies should track key data points such as client falls (the most frequent General Liability claim), allegations of failure to render services (a direct Professional Liability risk), and allegations of abuse/neglect, because high rates signal systemic shortcomings in training or care supervision. Monitoring this rate enables immediate loss-control interventions to address operational weaknesses and ultimately reduce future insurance claim payouts, the associated cost of deductibles and/or retentions, and, ultimately, premium costs.
To manage Workers’ Compensation premiums, which are heavily influenced by the Experience Modification Rate (Ex-Mod), home care agencies should track both claim frequency and severity, as well as reporting timeframes, using metrics such as the Total Recordable Incident Rate (TRIR) and Claim Lag Time.
The TRIR is a key metric used by organizations, particularly in high-risk industries like healthcare, to measure overall workplace safety performance and to help agencies benchmark their injury and illness rates against industry averages.
In contrast, Claim Lag Time—the number of days between injury and reporting—is highly predictive of final claim cost. Specifically, claims reported late will typically cost significantly more due to treatment delays and higher litigation risk, directly inflating the Ex-Mod; therefore, tracking a long lag time provides the actionable insight that a home care agency needs to fix a faulty employee and supervisor reporting culture to contain future claim costs.
The Caregiver Turnover Rate is the most significant predictor of future losses across all lines of coverage and operational efficiency. Home care agencies should track this metric because high turnover directly correlates with increased insurance claims, such as post-termination Workers’ Compensation and Employment Practices Liability claims, and General and Professional Liability claims, as new or inexperienced caregivers are statistically more likely to cause client falls or sustain lifting-related injuries. Also, having fewer caregivers due to high turnover can leave remaining caregivers feeling exhausted, overwhelmed, and overworked as they handle larger or more complex caseloads, further increasing the risk of injuries and claims. Lastly, high turnover contributes to substantial financial losses by being closely linked to increased missed or late visits and disruptions to care continuity, resulting in lost billable revenue and lower client satisfaction.
As an insurance broker leading a team that specializes in home care, our priority is to support multi-location or franchised operations by ensuring their insurance programs align with systemwide compliance and contractual requirements. My team begins by performing a thorough review to identify mandated insurance requirements and determine whether franchisors or referral partners need to be named as additional insureds across all locations.
Secondly, we actively mitigate risks stemming from varying state regulations and licensing laws. This means we endeavor to ensure that every local entity or franchisee meets its state’s unique statutory requirements for General and Professional Liability, Workers’ Compensation, and Fidelity Bonding/Crime Insurance, which often differ significantly from state to state.
Lastly, we offer proprietary training and safety incentive programs specifically for the in-home care sector, ensuring that all franchisees follow standard safety protocols while also demonstrating to insurance carriers that safety training, incentives, and compliance are managed proactively, leading to better pricing and underwriting stability for the entire portfolio.
This holistic, proactive approach defines how we move beyond simple policy placement to become a crucial compliance and risk-assurance partner, which is vital to the stable, sustainable growth of any multi-location or franchised home care business.
My team works closely with our underwriters to tackle cyber liability and data-breach risk by building protection around three core pillars, starting with customized policy placement. We ensure the Cyber Liability policy is precisely tailored for the unique exposures created by mobile EVV apps and Protected Health Information (PHI). This means securing coverage for crucial first-party costs, such as forensic investigation and HIPAA-mandated client notification, and third-party liability coverage that pays for defense costs and regulatory fines stemming from HIPAA/HITECH violations following a mobile data leak.
Further, given the reliance on these apps for billing, we insist on including Business Interruption coverage to offset lost revenue should a cyber event halt the agency’s operations.
To prepare a home care agency for rigorous underwriting, we strongly urge our clients to enhance their security controls, including implementing multi-factor authentication (MFA) for app access, verifying data encryption on mobile devices, and establishing formal incident response plans with remote-wiping capabilities for stolen devices.
Finally, we provide specialized advice on technology-specific risk mitigation to both improve security and lower insurance costs. We strongly advocate for Mobile Device Management (MDM) software, which ensures only secure, approved devices can access PHI via the app, mitigating the risk of lost or stolen caregiver phones. We also verify that the agency practices least-privilege access, ensuring that caregivers view only the minimum PHI necessary for their current visit. By strategically integrating customized insurance coverage, regulatory preparedness, and active technology controls, we deliver comprehensive protection against the unique cyber threats facing home care agencies.
As home care agencies scale operations across multiple states, new service lines, or franchising models, they must upgrade from reactive safety measures to a formal, holistic Enterprise Risk Management (ERM) program. This framework integrates risk identification and mitigation across all business units. Structuring the program involves centralized governance by a corporate risk committee to ensure consistent policies, while allowing local adaptability.
Standardizing operations, implementing rigorous training programs, leveraging technology such as RMIS (Risk Management Information System) for data analysis and compliance tracking, and developing a comprehensive compliance plan are essential structural components for managing risk proactively across the expanding organization.
A major pitfall to avoid is assuming a one-size-fits-all approach to regulations; each state has unique licensing and labor laws that require meticulous attention. Underinvestment in staff training is another significant pitfall, as inadequate preparation leads to higher injury rates, client-care errors, increased turnover, and spiraling insurance costs. When adding new service lines, home care agencies must also conduct specific risk assessments to address the unique liabilities associated with those services.
Operational failures during expansion often stem from critical gaps in communication and documentation protocols, which undermine the ability to defend claims. Furthermore, organizations should avoid rapid growth without a solid strategic plan for financial stability and risk integration. Sustainable scaling requires careful planning and continuous risk monitoring to ensure long-term stability and compliance across all locations and services.
At the end of the day, mastering insurance risk isn’t about collecting policies — it’s about protecting what matters most: your clients, your people, and the mission that brought you into care in the first place. As Mike Nutter shared, the right coverage paired with meaningful tracking — like falls, missed visits, and abuse reports — gives agencies the clarity to act before a claim becomes a crisis.
When leaders treat risk management as a tool for stronger operations instead of just a cost center, they build agencies that are safer, more resilient, and ready to grow with confidence
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